chapter 15 the wrist hand and fingers
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Chapter 15 – The Wrist, Hand, and Fingers

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Chapter 15 – The Wrist, Hand, and Fingers. Pages 556 - 559. Hand Pathology. Most injuries have acute onset Hyperflexion/hyperextension of wrist Axial load of metacarpal bones Crushing forces. Scaphoid Fractures. Bony block for wrist extension Blood supply Receives from distal end

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hand pathology
Hand Pathology
  • Most injuries have acute onset
    • Hyperflexion/hyperextension of wrist
    • Axial load of metacarpal bones
    • Crushing forces
scaphoid fractures
Scaphoid Fractures
  • Bony block for wrist extension
  • Blood supply
    • Receives from distal end
    • Fracture may compromise nutrition to proximal end
    • High incidence of nonunion or malunion fractures secondary to avascular necrosis
    • Figure 15-27, page 557
scaphoid fractures1
Scaphoid Fractures
  • Preiser’s Disease
    • Osteoporosis of scaphoid due to fx or repeated trauma
  • Signs and Symptoms
    • Aching pain in anatomical snuffbox area
    • Grip strength decreased
  • Evaluative Findings
    • Table 15-9, page 558
scaphoid fractures2
Scaphoid Fractures
  • Pain in anatomical snuffbox area after hyperextension mechanism should be treated as scaphoid fracture
  • Treatment
    • Immobilization of wrist and thumb
    • Referral to physician
    • Fx may not be visible on x-ray right away
scaphoid fractures3
Scaphoid Fractures
  • Conservative Treatment
    • Short arm thumb spica cast
    • Long arm thumb spica cast
      • Eliminates pronation and supination
      • May decrease risk of non- and malunions
  • Surgical Treatment
    • Displaced fractures
    • Some may chose to immediately fixate fracture
  • After healing phase, ROM and strengthening
perilunate and lunate dislocation
Perilunate and Lunate Dislocation
  • Series of events
    • As limits of wrist/hand extension are exceeded– scaphoid strikes radius
    • Rupturing of volar ligaments that connect scaphoid to lunate
    • As force continues, distal carpal row is stripped away from lunate
    • Lunate rests dorsally relative to other carpals
    • This is a Perilunate Dislocation
perilunate and lunate dislocation1
Perilunate and Lunate Dislocation
  • Series of events cont.
    • Further extension leads to rupture of dorsal ligaments
    • This relocates the carpals and rotates the lunate
    • Lunate rests volarly relative to other carpals
    • This is a lunate dislocation
  • Either dislocation may spontaneously reduce
perilunate and lunate dislocation2
Perilunate and Lunate Dislocation
  • Signs and Symptoms
    • Pain along radial side of palmar or dorsal aspect of wrist that limits ROM
    • Bulge may be visible on dorsal or palmar aspect proximal to third metacarpal
    • Paresthesia in middle finger
  • Fracture of scaphoid should be suspected
perilunate and lunate dislocation3
Perilunate and Lunate Dislocation
  • Evaluative Findings
    • Table 15-10, page 558
  • Kienbock’s Disease
    • Osteochondritis or slow degeneration of lunate
    • Due to repetitive trauma that may compromise vascular supply
    • May result in loss of ulnar deviation, tenderness, pain, swelling, decreased grip strength
    • Characteristic – pain during passive extension of third finger
perilunate and lunate dislocation4
Perilunate and Lunate Dislocation
  • Treatment
    • Closed reduction and immobilization in flexion for 6-8 weeks
    • Frequent follow-ups
    • Pinning may be needed if reduction is lost
metacarpal fractures
Metacarpal Fractures
  • Common for athlete to hear the bone snapping as it fractures
    • Immediate pain
    • Gross deformity may be visible or obscured by swelling (Figure 15-28, page 559)
    • Palpation reveals tenderness, crepitus, false joint
  • Evaluative Findings
    • Table 15-11, page 560
metacarpal fractures1
Metacarpal Fractures
  • Long bone compression test
    • Figure 15-29, page 559
  • Boxer’s fracture
    • Fifth metacarpal
    • Depressed 5th MCP joint
metacarpal fractures2
Metacarpal Fractures
  • Treatment
    • If no rotation – casting
    • With rotation – open reduction with internal fixation
    • After healing phase – ROM and strengthening (approximately 8 weeks after fracture)
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